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Avoid shared-service billing, time miscalculations for critical care codes

07/04/2016

Avoid miscalculating the time your providers spent with a critically injured patient when you report critical care services (99291-99292) to avoid an unintended upcharge – and a potential recoupment of payment.

Shared Savings rule finalized; lower-performing ACOs get a break

07/04/2016

by: Roy Edroso

The Shared Savings rule finalized on June 6 makes things slightly easier for new entrants in the Medicare ACO program — particularly those in high-cost areas.

OIG cites lax oversight of provider-based clinics, urges elimination of pay disparity

07/04/2016

by: Scott Kraft

The provider-based designation for physician clinics owned by hospitals continues to cause problems, including overpayments due to coding errors and lax oversight of whether facilities designated as provider-based clinics meet Medicare requirements, the HHS Office of Inspector General (OIG) charged in a recent report.

SBIRT alcohol and drug screening resource: Annual questionnaire

06/27/2016

by: Richard Scott

Physician practices can provide alcohol and drug screening services in the office through the Medicare-covered screening, brief intervention and referral to treatment (SBIRT) services, which use HCPCS codes G0442, G0443 and G0396.

SBIRT alcohol and drug screening resource: AUDIT questionnaire

06/27/2016

by: Richard Scott

Many practices underutilize SBIRT services, according to coding and billing experts. Use the questionnaires provided here, including the Alcohol Use Disorders Identification Test (AUDIT), to begin providing alcohol and drug screening to your patients – and get paid for those services.

Conduct SBIRT services for patients with potential substance abuse problems

06/27/2016

by: Richard Scott

Install a plan to document and code for alcohol and drug screening services to avoid losing out on reimbursement for work that can greatly benefit your patients — some of which your practice may already be doing.

4 common Medicare Advantage plan problems – and how to fix them

06/27/2016

by: Roy Edroso

If you’re looking to contract with Medicare Advantage (MA) plans, or are having trouble with the ones you have, be prepared to address issues promptly, insist on your rights and make sure your MA patients are informed.

SCOTUS takes broad view of False Claims Act; watch your non-CMS compliance

06/27/2016

by: Roy Edroso

A recent Supreme Court decision on the applicability of the False Claims Act may encourage prosecutors to come after you for fraud not directly related to Medicare regulations — including such seemingly irrelevant errors as failing to maintain proper licensure on NPPs.

Mid-year OIG Work Plan update has modest impact on practices

06/27/2016

by: Scott Kraft

Revisions and new items added to the HHS Office of Inspector General’s 2016 Work Plan as part of the mid-year update are more likely to hit hospitals and home health agencies than physician practices, but there are still a handful of key changes that affect physician groups.

CMS slaps billing restrictions on 370-plus codes under latest MUE release

06/27/2016

by: Richard Scott

Add new billing caps to your claims-submission process because the latest quarterly update to the Correct Coding Initiative’s (CCI) collection of medically unlikely edits (MUEs) introduces new limits on 373 services and revises another 21 services.

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